Modern Management of Complex Tympanojugular Paragangliomas: Systematic Review and Meta-Analysis

Rajiv Dharnipragada, John T. Butterfield, Sanjay Dhawan, Meredith E. Adams, Andrew S. Venteicher

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations


Objective: Tympanojugular paragangliomas (TJPs) are slow-growing tumors arising within the middle ear or jugular foramen. The development of modified skull base approaches and the increasing use of stereotactic radiosurgery have provided more modern techniques in the management of TJPs. Several factors dictating approach selection, and resulting clinical outcomes have been inconsistently described. Methods: A systematic review of the literature describing modern management of complex TJPs was performed and summarized. A random-effects meta-analysis was performed to describe the rate of tumor control, complications, and symptom improvement in patients undergoing radiosurgery or surgical resection. Results: Nineteen studies were identified with a total of 852 TJP patients. A minority (153 patients) underwent radiosurgery while 699 underwent surgery. On meta-analysis, there was a 3.5% (95% confidence interval [CI]: 0.5%–6.4%) tumor growth rate following radiosurgery and 3.9% (95% confidence interval [CI]: 1.8%−6.0%) recurrence rate in surgical resection, with no significant moderator effect between the 2 groups (P = 0.9046). Complication rate for radiosurgery was 7.6% (95% CI: 2.8%–12.4%), differing significantly from surgical complication rates of 29.6% (95% CI: 17.1–42.0%, P = 0.0418). Conclusions: Stereotactic radiosurgery and surgical resection for TJPs have similar rates of tumor recurrence. Radiation is associated with less risk and lower morbidity, yet there is comparably modest reduction of the tumor size. In sum, the data suggest that radiosurgery is a reasonable management option for patients with minimal symptoms who are high risk for surgery. Microsurgical resection should be reserved for patients with lower cranial neuropathies or those who have failed radiation treatment.

Original languageEnglish (US)
Pages (from-to)149-156.e3
JournalWorld neurosurgery
StatePublished - Feb 2023

Bibliographical note

Funding Information:
Disclosures: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher Copyright:
© 2022 Elsevier Inc.


  • Glomus jugulare
  • Infratemporal fossa
  • Meta-analysis
  • Skull base
  • Stereotactic radiosurgery
  • Tympanojugular pararanglioma

PubMed: MeSH publication types

  • Meta-Analysis
  • Systematic Review
  • Journal Article
  • Review


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